title: On the alert: future priorities for alerts in clinical decision support for computerized physician order entry identified from a European workshop.
abstract: BACKGROUND
  Clinical decision support (CDS) for electronic prescribing systems (computerized physician order entry) should help prescribers in the safe and rational use of medicines. However, the best ways to alert users to unsafe or irrational prescribing are uncertain. Specifically, CDS systems may generate too many alerts, producing unwelcome distractions for prescribers, or too few alerts running the risk of overlooking possible harms. Obtaining the right balance of alerting to adequately improve patient safety should be a priority.
  
  
  METHODS
  A workshop funded through the European Regional Development Fund was convened by the University Hospitals Birmingham NHS Foundation Trust to assess current knowledge on alerts in CDS and to reach a consensus on a future research agenda on this topic. Leading European researchers in CDS and alerts in electronic prescribing systems were invited to the workshop.
  
  
  RESULTS
  We identified important knowledge gaps and suggest research priorities including (1) the need to determine the optimal sensitivity and specificity of alerts; (2) whether adaptation to the environment or characteristics of the user may improve alerts; and (3) whether modifying the timing and number of alerts will lead to improvements. We have also discussed the challenges and benefits of using naturalistic or experimental studies in the evaluation of alerts and suggested appropriate outcome measures.
  
  
  CONCLUSIONS
  We have identified critical problems in CDS, which should help to guide priorities in research to evaluate alerts. It is hoped that this will spark the next generation of novel research from which practical steps can be taken to implement changes to CDS systems that will ultimately reduce alert fatigue and improve the design of future systems.
authors.affiliation: University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB UK. j.j.coleman@bham.ac.uk.
authors.forename: Jamie J
authors.initials: JJ
authors.lastname: Coleman
authors.forename: Heleen
authors.initials: H
authors.lastname: van der Sijs
authors.forename: Walter E
authors.initials: WE
authors.lastname: Haefeli
authors.forename: Sarah P
authors.initials: SP
authors.lastname: Slight
authors.forename: Sarah E
authors.initials: SE
authors.lastname: McDowell
authors.forename: Hanna M
authors.initials: HM
authors.lastname: Seidling
authors.forename: Birgit
authors.initials: B
authors.lastname: Eiermann
authors.forename: Jos
authors.initials: J
authors.lastname: Aarts
authors.forename: Elske
authors.initials: E
authors.lastname: Ammenwerth
authors.forename: Ann
authors.initials: A
authors.lastname: Slee
authors.forename: Robin E
authors.initials: RE
authors.lastname: Ferner
authors.forename: Robin E
authors.initials: RE
authors.lastname: Ferner
authors.forename: Ann
authors.initials: A
authors.lastname: Slee
mesh_terms: D020000:Decision Support Systems, Clinical / Q000592:standards*; D055695:Electronic Prescribing / Q000592:standards*; D005060:Europe; D006801:Humans; D050316:Medical Order Entry Systems / Q000592:standards*; D012680:Sensitivity and Specificity